Тypes of hemorrhage

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Plan

Main

1. Etymology

2. Classification

3. First Aid for Traumatic Bleeding

4. The slaughtering of animals in the meat industry

Conclusion

List of references

Main

Bleeding, technically known as hemorrhaging or haemorrhaging (see American and British spelling differences), is bloodescaping from the circulatory system. Bleeding can occur internally, where blood leaks from blood vessels inside the body, or externally, either through a natural opening such as the mouth, nose, ear, urethra, vagina or anus, or through a break in the skin. Hypovolemia is a massive decrease in blood volume, and death by excessive loss of blood is referred to as exsanguination. Typically, a healthy person can endure a loss of 10-15% of the total blood volume without serious medical difficulties (by comparison, blood donation typically takes 8-10% of the donor's blood volume).http://en.wikipedia.org/wiki/Bleeding - cite_note-3 The stopping or controlling of bleeding is calledhemostasis and is an important part of both first aid and surgery.

1. Etymology

The word "Haemorrhage" comes from Latin haemorrhagia, from Ancient Greek б?мпссбгЯб (haimorrhagнa, “a violent bleeding”), from б?мпссбгЮт (haimorrhag?s, “bleeding violently”), from б?мб (haоma, “blood”) + -сбгЯб (-ragнa), from ?згнэнбй (rhзgnъnai, “to break, burst”).

2. Classification

Blood loss

Hemorrhaging is broken down into four classes by the American College of Surgeons' advanced trauma life support (ATLS).

· Class I Hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary.

· Class II Hemorrhage involves 15-30% of total blood volume. A patient is often tachycardic (rapid heart beat) with a narrowing of thedifference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient may exhibit slight changes in behavior. Volume resuscitation with crystalloids (Saline solution or Lactated Ringer's solution) is all that is typically required. Blood transfusion is not typically required.

· Class III Hemorrhage involves loss of 30-40% of circulating blood volume. The patient's blood pressure drops, the heart rateincreases, peripheral hypoperfusion (shock), such as capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystalloid and blood transfusion are usually necessary.

· Class IV Hemorrhage involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death.

This system is basically the same as used in the staging of hypovolemic shock.

Individuals in excellent physical and cardiovascular shape may have more effective compensatory mechanisms before experiencing cardiovascular collapse. These patients may look deceptively stable, with minimal derangements in vital signs, while having poor peripheral perfusion. Elderly patients or those with chronic medical conditions may have less tolerance to blood loss, less ability to compensate, and may take medications such as betablockers that can potentially blunt the cardiovascular response. Care must be taken in the assessment of these patients. exsanguination bleeding traumatic organs

' Bleeding' denotes hemorrhage as a result of an underlying medical condition (i.e. causes of bleeding that are not directly due to trauma). Blood can escape from blood vessels as a result of 3 basic patterns of injury:

· Intravascular changes - changes of the blood within vessels (e.g. ^ blood pressure, v clotting factors)

· Intramural changes - changes arising within the walls of blood vessels (e.g. aneurysms, dissections, AVMs, vasculitides)

· Extravascular changes - changes arising outside blood vessels (e.g. H pylori infection, brain abscess, brain tumor)

The underlying scientific basis for blood clotting and hemostasis is discussed in detail in the articles, Coagulation, hemostasis and related articles. The discussion here is limited to the common practical aspects of blood clot formation which manifest as bleeding.

Certain medical conditions can also make patients susceptible to bleeding. These are conditions that affect the normal "hemostatic" functions of the body. Hemostasis involves several components. The main components of the hemostatic system include platelets and the coagulation system.

Platelets are small blood components that form a plug in the blood vessel wall that stops bleeding. Platelets also produce a variety of substances that stimulate the production of a blood clot. One of the most common causes of increased bleeding risk is exposure to non-steroidal anti-inflammatory drugs (or "NSAIDs"). The prototype for these drugs is aspirin, which inhibits the production of thromboxane. NSAIDs inhibit the activation of platelets, and thereby increase the risk of bleeding. The effect of aspirin is irreversible; therefore, the inhibitory effect of aspirin is present until the platelets have been replaced (about ten days). Other NSAIDs, such as "ibuprofen" (Motrin) and related drugs, are reversible and therefore, the effect on platelets is not as long-lived.

There are several named coagulation factors that interact in a complex way to form blood clots, as discussed in the article on coagulation. Deficiencies of coagulation factors are associated with clinical bleeding. For instance, deficiency of Factor VIII causes classic Hemophilia A while deficiencies of Factor IX cause "Christmas disease"(hemophilia B). Antibodies to Factor VIII can also inactivate the Factor VII and precipitate bleeding that is very difficult to control. This is a rare condition that is most likely to occur in older patients and in those with autoimmune diseases. von Willebrand disease is another common bleeding disorder. It is caused by a deficiency of or abnormal function of the "von Willebrand" factor, which is involved in platelet activation. Deficiencies in other factors, such as factor XIII or factor VII are occasionally seen, but may not be associated with severe bleeding and are not as commonly diagnosed.

In addition to NSAID-related bleeding, another common cause of bleeding is that related to the medication, warfarin ("Coumadin" and others). This medication needs to be closely monitored as the bleeding risk can be markedly increased by interactions with other medications. Warfarin acts by inhibiting the production of Vitamin K in the gut. Vitamin K is required for the production of the clotting factors, II, VII, IX, and X in the liver. One of the most common causes of warfarin-related bleeding is taking antibiotics. The gut bacteria make vitamin K and are killed by antibiotics. This decreases vitamin K levels and therefore the production of these clotting factors.

Deficiencies of platelet function may require platelet transfusion while deficiencies of clotting factors may require transfusion of either fresh frozen plasma or specific clotting factors, such as Factor VIII for patients with hemophilia.

Bleeding is the name commonly used to describe blood loss. It can refer to blood loss inside the body (internal bleeding) or blood loss outside of the body (external bleeding).

Blood loss can occur in almost any area of the body. Typically, internal bleeding occurs when blood leaks out through damage to a blood vessel or organ. External bleeding occurs either when blood exits through a break in the skin, or when blood exits through a natural opening in the body, such as the mouth, vagina, or rectum. Bleeding is a very common symptom that can be caused by a variety of incidents or conditions. Possible causes include:

Traumatic Bleeding

Traumatic bleeding is caused by an injury. Injuries can vary in severity, but most will cause bleeding to some degree. Common types of traumatic injury include:

· abrasions or grazes that do not penetrate below the skin

· hematoma or bruises

· lacerations or incisions

· puncture wounds from items such as a needle or knife

· crushing injuries

· gunshot wounds (caused by a weapon such as a gun)

There are also a number of medical conditions that can cause bleeding. This is generally rarer than traumatic bleeding but can still happen to varying degrees. Conditions that can cause bleeding include:

· haemophilia

· leukemia

· liver disease

· menorrhagia

· thrombocytopenia

· Von Willebrand's disease

· vitamin K deficiency

· brain trauma

· bowel obstruction

· congestive heart failure

· lung cancer

· acute bronchitis

Some medicines can increase your chances of bleeding or even cause bleeding. Typically, you will be warned about this and advised what to do when you are first prescribed the medication.

Medications that may be responsible for bleeding include:

· blood-thinning medications

· antibiotics, when used on a long-term basis

· radiation therapy

Emergency Issues

If bleeding is severe, call an ambulance immediately. You should also seek emergency help if you suspect internal bleeding, as this can quickly become life threatening.

People who suffer from bleeding disorders or take blood thinners should also seek emergency help in order to stop the bleeding as quickly as possible.

Seek medical help if:

· the person has gone into shock or has a fever

· the bleeding cannot be controlled using pressure

· the wound requires a tourniquet

· the bleeding was caused by a serious injury

· the wound may need stitches to stop bleeding

· foreign objects are stuck inside the wound

· the wound appears to be becoming infected (such as swelling or leaking a yellow or brown fluid, or has redness)

· the injury occurred due to a bite from an animal or human.

When you call for help, the emergency services will advise you on what to do and of their approximate arrival time. In most cases, you will be advised to continue to put pressure on the wound and to keep reassuring the patient. You may also be told to lay the person down to reduce the risk of fainting.

When treating bleeding, it is important to find out why the bleeding is occurring and then to stop it as quickly as possible. If the bleeding is caused by a medical condition, emergency care will be needed immediately.

3. First Aid for Traumatic Bleeding

It is possible to treat external traumatic bleeding. Be sure to seek emergency help if the patient fits any of the criteria above, or if you need help to stop the bleeding. First, try to calm the injured person, and reassure him or her. Bleeding can be very scary, and reassurance is essential to avoid shock.

Lay the person down as soon as possible to reduce the risk of fainting. Try to elevate the area that is bleeding, if possible.

Remove loose debris and foreign particles carefully from the wound. Leave large items such as knives, arrows or weapons where they are. Removing these objects can cause further harm and will likely increase the bleeding. In this case, use bandages and pads to keep the object in place and absorb the bleeding. Use a clean cloth, bandage, clothing, or your hands to put pressure directly onto the wound. Maintain a medium pressure until the bleeding has slowed, and eventually stops. Do not remove the cloth when bleeding stops. Use an adhesive tape or clothing to wrap around the dressing and hold it in place. Place a cold pack over the wound. Do not look at the wound to see if bleeding has stopped, as this can disturb the wound and cause it to begin bleeding again. Do not remove the cloth from the wound, even if blood seeps through the material. Add more material on top, and continue the pressure. Do not move anyone with a head, neck, back, or leg injury. Do not apply pressure to an eye injury. Tourniquets should only be used as a last resort. Ideally, a tourniquet should be applied by an experienced person. If a tourniquet is needed, follow these steps:

· Identify where to place the tourniquet. It should be applied to a limb between the heart and the bleeding.

· Make the tourniquet using bandages, if possible. Wrap them around the limb, and tie a half knot. Ensure there is enough room to tie another knot with the loose ends.

· A stick or rod should be placed between the two knots.

· Twist the stick to tighten the bandage.

· Secure the tourniquet in place with tape or cloth.

· Check the tourniquet every 10 minutes. If the bleeding slows enough to be sufficiently controllable with pressure, release the tourniquet and apply direct pressure instead.

If bleeding is caused by a serious injury, bleeding cannot be controlled, or if the bleeding is internal, you will need emergency medical care.

Typically, paramedics will attempt to control the bleeding before rushing you to hospital. In some cases, care might be given at home or by using a stretcher. The treatment required will depend on the cause of the bleeding.

In rare cases, surgery may be required to stop bleeding. Anyone who experiences unexplained bleeding should be seen by a medical professional.

Traumatic bleeding

If bleeding is caused by an injury or accident, it may be stopped with minor first aid. Typically, the wound will then heal naturally and no further care is needed. If bleeding is caused by a medical condition, and the condition is not identified or diagnosed, the bleeding is likely to reoccur.

Any bleeding that is allowed to continue without medical treatment could potentially cause bleeding to death. Typically, people need to lose between one-third and one-half of their total blood before they bleed to death. Bleeding to death is a very uncommon way for humans to die.

Exsanguination (bleeding to death) can occur without any external bleeding. Catastrophic internal hemorrhages can cause a great deal of blood loss, as can aneurysms.

Exsanguination is the process of blood loss, to a degree sufficient to cause death. One does not have to lose all of one's blood to cause death. Depending upon the age, health, and fitness level of the individual, people can die from losing half or two-thirds of their blood; a loss of roughly one-third of the blood volume is considered very serious. Even a single deep cut can warrant suturing and hospitalization, especially if trauma, a vein or artery, or another comorbidity is involved. It is most commonly known as "bleedingto death" or colloquially as "bleeding out". The word itself originated from Latin: ex ("out of") and sanguis ("blood").

4. The slaughtering of animals in the meat industry

Exsanguination is used as a method of slaughter. Before the fatal incision is made, the animal may be rendered insensible to pain by various methods, including captive bolt, electricity or chemical. Without prior sedation, stunning or anesthetic, this method of slaughter is understood by some to cause a high degree of anxiety, although other studies contradict these findings.http://en.wikipedia.org/wiki/Exsanguination - cite_note-schulze_halastudy-2 The captive bolt is placed against the skull of the animal, and penetrates to cause tissue destruction in the brain, incapacitating the animal so that the procedure may take place. Electricity is used mostly in porcine, poultry and domestic sheep, whereas chemical is used in injured livestock.

Quickly after the animal is incapacitated it is hung upside down by its hind limbs and an extremely sharp knife, in an orientation parallel to the ground, is fully inserted through the skin just behind the point of the jaw and below the neck bones. From this position, the knife is drawn forward away from the spine to sever the jugular veins, carotid arteries, andtrachea. Properly performed, blood will flow freely and death will occur within seconds. Sheep and swine will reach brain death in under 10 seconds; however, larger animals, notably cattle may take up to 45 seconds to reach brain death. This period may extend to a couple of minutes if complications, such as arterial occlusion, occur. However, the animal's inverted position allows blood to flow more precipitously and thus makes an animal regaining consciousness before it is fully exsanguinated highly unlikely. In any case, animal welfare advisory councils clearly emphasize that the time from incapacitation to start of exsanguination should be prompt; recommending a time under 15 seconds.

Beyond the initial cost of purchasing a captive bolt, continued usage of the method is very inexpensive. The animal is incapacitated for the duration of the procedure, so it is one of the safest methods for the slaughterer.

Slaughter by exsanguination is mandated by Judaic kashrut (kosher) and Islamic dhabihah (halal) dietary laws. The double edged pointed knife is prohibited. Instead, a long knife with a squared off end is used that in Jewish law must be at least twice the width of the animal's neck. The operation of sticking or exsanguination is executed faster than when using the pointed knife, as four large blood vessels in the neck are severed simultaneously.

A 1978 study at the University of Veterinary Medicine Hanover indicates that these traditional methods, when executed as prescribed by the religious authorities, gave results which proved "...pain and suffering to the extent as has since long been generally associated in public with this kind of slaughter cannot be registered..." and that "[a complete loss of consciousness] occurred generally within considerably less time than during the slaughter method after captive bolt stunning."

In Islamic and Jewish law, captive bolts and other methods of pre-slaughter paralysis are generally not permissible, as consumption of animals found dead are regarded ascarrion and stunned animals that are later killed will come into this category.

Various halal food authorities have more recently permitted the use of a recently developed fail-safe system of head-only stunning using a mushroom shaped hammer head that delivers a blow that is not fatal, proved by it being possible to reverse the procedure and revive the animal after the shock.

Exsanguination is a relatively uncommon, but dramatic, cause of death in human beings. Traumatic injury can cause exsanguination if bleeding is not promptly controlled, and is the most common cause of death in military combat. Non-combat causes can include gunshot or stab wounds; motor vehicle crash injuries; suicide by severing arteries, typically those in the wrists; and partial or total limb amputation, such as via accidental contact with a circular or chain saw, or become entangled in operating machinery.

Patients can also develop catastrophic internal hemorrhages, such as from a bleeding peptic ulcer, postpartum bleeding or splenic hemorrhage, which can cause exsanguination without any external signs of distress. Another cause of exsanguination in the medical field is that of aneurysms. If a dissecting aortic aneurysm ruptures through the adventitia, massive hemorrhage and exsanguination can result in a matter of minutes.

Blunt force trauma to the liver, kidneys, and spleen can cause severe internal bleeding as well, though the abdominal cavity usually becomes visibly darkened as if bruised. Similarly, trauma to the lungs can cause bleeding out, though without medical attention, blood can fill the lungs causing the effect of drowning, or in the pleura causing suffocation, well before exsanguination would occur. In addition, serious trauma can cause tearing of major blood vessels without external trauma indicative of the damage.

Alcoholics and others with liver disease can also suffer from exsanguination. Thin-walled, normally low pressure dilated veins just below the lower esophageal mucosa calledesophageal varices can become enlarged in conditions with portal hypertension. These may begin to bleed, which with the high pressure in the portal system can be fatal. The often causative impaired liver function also reduces the availability of clotting factors (many of which are made in the liver), making any rupture in vessels more likely to cause a fatal loss of blood.

Conclusion

Exsanguination is the process of blood loss, to a degree sufficient to cause death. One does not have to lose all of one's blood to cause death. Depending upon the age, health, and fitness level of the individual, people can die from losing half or two-thirds of their blood; a loss of roughly one-third of the blood volume is considered very serious. Even a single deep cut can warrant suturing and hospitalization, especially if trauma, a vein or artery, or another comorbidity is involved. It is most commonly known as "bleedingto death" or colloquially as "bleeding out". The word itself originated from Latin: ex ("out of") and sanguis ("blood").

Exsanguination is used as a method of slaughter. Before the fatal incision is made, the animal may be rendered insensible to pain by various methods, including captive bolt, electricity or chemical. Without prior sedation, stunning or anesthetic, this method of slaughter is understood by some to cause a high degree of anxiety, although other studies contradict these findings.http://en.wikipedia.org/wiki/Exsanguination - cite_note-schulze_halastudy-2 The captive bolt is placed against the skull of the animal, and penetrates to cause tissue destruction in the brain, incapacitating the animal so that the procedure may take place. Electricity is used mostly in porcine, poultry and domestic sheep, whereas chemical is used in injured livestock.

List of references

1. AVMA Guidelines for the Euthanasia of Animals: 2013 Edition. American Veterinary Medical Association. 2013. ISBN 978-1-882691-21-0.

2. Schulze W, Schultze-Petzold H, Hazem AS, Gross R. Experiments for the objectification of pain and consciousness during conventional (captive bolt stunning) and religiously mandated (“ritual cutting”) slaughter procedures for sheep and calves. Deutsche Tierдrztliche Wochenschrift 1978 Feb 5;85(2):62-6. English translation by Dr Sahib M. Bleher

3. Masood Khawaja (6 October 2001). "Definition of Halal". Halal Food Authority. Archived from the original on 2009-04-27. Retrieved 2011-10-24.

4. Hoff J, Rlagt LV. Methods of blood collection in the mouse. Lab animals. 2000;29:47-53.

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